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Billing news

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Modified: 3/5/2018
There will be a common working file (CWF) “dark day” on Friday, March 30.
Modified: 4/12/2018
The Centers for Medicare & Medicaid Services (CMS) has issued a national coverage determination (NCD) to cover SET for beneficiaries with intermittent claudication (IC) for the treatment of symptomatic PAD. The article was revised March 5 to reflect a revised change request (CR). The MAC implementation date, CR release date, transmittal numbers and the web addresses of the transmittals were revised. The article was revised April 5 to reflect a revised CR. The MAC implementation date, CR release date, transmittal numbers, and the web addresses of the transmittals were revised. In addition, the article and CR were revised to delete place of service codes 19 and 22 as acceptable places of service for CPT 93668. The article was revised April 11 to clarify that the SET program must be provided in a physician’s office (place of service code 11). All other information remains the same. [MM10295]
Modified: 4/11/2018
Learn which modifier to use when you expect Medicare will deny a claim that does not meet medical necessity criteria and whether you have or do not have an advanced beneficiary notice (ABN) signed by the beneficiary.
Modified: 4/6/2018
This article provides information regarding unsolicited/voluntary refunds; that is, monies received by Medicare not related to an open account receivable.
Modified: 4/3/2018
Change request (CR) 10567 revises the skilled nursing facility (SNF) advance beneficiary notice of non-coverage (ABN) and discontinuing the five SNF denial letters. [MM10567]
Modified: 4/2/2018
Modifier 50 should not be used to report bilateral procedures furnished in ambulatory surgical centers (ASCs). This article details recent inappropriate use of modifier 50 by ASCs.
Modified: 4/2/2018
This special edition article reminds laboratories and other providers about how to properly bill for specimen validity testing done in conjunction with drug testing. [SE18001]
Modified: 4/2/2018
Change request (CR) 10521 provides clarification for billing Part A claims that do not contain a covered/billable drug charge. [MM10521]
Modified: 3/27/2018
Change request (CR) 10494 provides Medicare administrative contractors directions to initiate non-monetary mass adjustments to qualified Medicare beneficiaries (QMB) claims impacted by CR 9911. The goal is to produce replacement Medicare RAs that providers can submit to supplemental payers to coordinate benefits as necessary. Last sentence in “Note” added to clarify when this change will be seen. [MM10494]
Modified: 3/23/2018
This article reviews specific points that providers should consider regarding CCM guidelines, along with a link to a Medicare Learning Network® (MLN®) article that outlines the CCM guidelines in more detail.
Modified: 3/23/2018
All Medicare physicians, providers, and suppliers who offer services and supplies to qualified Medicare beneficiaries (QMB) may not bill QMBs for Medicare cost-sharing. This article was revised March 22 to include updated information about the remittance advice and Medicare summary notice for all Medicare fee-for-service QMB claims. It also includes new statistics on the number of beneficiaries enrolled in QMB. [SE1128]
Modified: 3/19/2018
Change request 10512 updates Medicare manuals with regard to skilled nursing facility (SNF) policy to clarify the existing content. No policy, processing, or system changes are anticipated. [MM10512]
Modified: 3/15/2018
Change request (CR) 10433 reestablishes all changes in CR 9911 to the Medicare remittance advice and Medicare summary notice by including qualified Medicare beneficiary (QMB) messages and reflecting $0 cost-sharing liability for the period beneficiaries are enrolled in QMB. This article was revised March 13 to reflect an updated CR. That CR added CARCs 66, 247, and 248. Durable medical equipment Medicare contractors (DME MACs) were added to the “Providers Affected” section. The QMB enrollment numbers were also updated to reflect 2016 statistics and pharmacies were included in the “Background” section. The CR date, transmittal number, and link to the transmittal also changed. [MM10433]
Modified: 3/5/2018
Change request (CR) 10481 releases information regarding the new modifier QQ that may be reported on the same claim line as the procedure code for an advanced diagnostic imaging service furnished in an applicable setting and paid for under an applicable payment system. [MM10481]
Modified: 3/2/2018
The Centers for Medicare & Medicaid Services (CMS) recently issued the 2018 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee for service program. [MM10405]
Modified: 2/14/2018
To correct claims returned for beneficiary name and number mismatch, take the following action. [CR 7260]
Modified: 1/29/2018
Review information from CMS about its action regarding recently expired Medicare legislative provisions.
Modified: 1/17/2018
This information outlines the process for the 935 recoupment.
Modified: 1/17/2018
To determine if a claim was medically reviewed, providers should look at certain fields on the claim screen. [Provider Outreach and Education]
Modified: 12/29/2017
The interest period begins on the day after payment is due and ends on the day of payment. The new rate of 2.625 percent is in effect, from January 1, 2018, through June 30, 2018. [Publication 100-04, Chapter 1, Section 80.2.2]
Modified: 12/26/2017
The Centers for Medicare & Medicaid Services (CMS) recently issued the 2016 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee for service program. [MM9410]
Modified: 12/24/2017
The Centers for Medicare & Medicaid Services (CMS) recently issued the 2017 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee for service program. [MM9902]
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.